Perioperative Changes in Serum Transaminases Levels Predicts Long-Term Survival Following Liver Resection of Hepatocellular Carcinoma

Jingming Lu ^1,2, Fumin Wang ^1,2, Wei Zhang

¹Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.
²School of Future Technology, Xi'an Jiaotong University, Xi'an, People's Republic of China.
³Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University, Shanghai, People's Republic of China.
⁴Department of Surgery, Ospedale San Raffaele, Milano, Italy.
⁵Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
⁶Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France.
⁷Department of Surgery, Westmead Hospital, Sydney, Australia.
⁸Department of Surgery, Stanford University, Stanford, CA, USA.
⁹Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
¹⁰Department of Surgery, University of Ottawa, Ottawa, Canada.
¹¹Department of Surgery, University of Verona, Verona, Italy.
¹²Department of Surgery, School of Medicine, The University of Sydney, Sydney, Australia.
¹³Yokohama City University School of Medicine, Yokohama, Japan.
¹⁴Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China. xfzhang125@xjtu.edu.cn.
¹⁵School of Future Technology, Xi'an Jiaotong University, Xi'an, People's Republic of China. xfzhang125@xjtu.edu.cn.
¹⁶Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA. Tim.Pawlik@osumc.edu.

⁰Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China.

Annals of Surgical Oncology +

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December 28, 2024

View abstract on PubMed

Summary

Perioperative liver injury markers, aspartate aminotransferase (AST) and alanine aminotransferase (ALT), predict outcomes after liver cancer surgery. Elevated AST/ALT ratios indicate higher risks for recurrence and mortality in hepatocellular carcinoma (HCC) patients.

Area Of Science

Hepatobiliary surgery
Surgical oncology
Translational research

Background

Hepatocellular carcinoma (HCC) resection can involve hepatic ischemia/reperfusion (I/R) injury.
Perioperative liver enzyme levels, specifically AST and ALT, are routinely measured.
The impact of I/R-induced transaminase changes on long-term HCC outcomes remains unclear.

Purpose Of The Study

To determine if perioperative AST and ALT levels correlate with long-term outcomes after HCC resection.
To investigate the predictive value of I/R injury markers for recurrence and survival in HCC patients.

Main Methods

A murine model of HCC recurrence with and without I/R injury was established.
Patient data from multi-institutional cohorts (DC and VC) undergoing curative HCC resection were analyzed.
Perioperative transaminase changes were quantified using the sum of AST/ALT ratios (SAAR) and correlated with recurrence-free survival (RFS) and overall survival (OS).

Main Results

Mice with hepatic I/R injury showed increased tumor recurrence and luminescence.
In 734 patients, SAAR on postoperative days 1 and 3 predicted outcomes.
SAAR ≥ 2.0 was associated with increased recurrence risk (HR 1.32), and SAAR ≥ 3.5 with mortality risk (HR 1.86).
SAAR demonstrated good predictive accuracy for recurrence and mortality in both cohorts.

Conclusions

Routine laboratory tests, AST and ALT, can identify patients at high risk of recurrence and mortality post-HCC resection.
The SAAR metric offers a valuable tool for risk stratification in HCC patients.
This finding supports incorporating perioperative liver enzyme monitoring into HCC management strategies.

Keywords:

Hepatocellular carcinoma Prediction model Recurrence Resection Transaminase